Ethical conflicts break out when doctors serve teams, players

Sports medicine is an industry teeming with potential conflicts of interest.

Just how do doctors satisfy the demands of team management, which might want the talented and highly paid athlete to play through an injury, while at the same time respecting the needs of the athlete?

And how does management reconcile that the athlete's care may go to the highest bidder  not necessarily the best qualified physicians  given that the team's medical care now represents a sizable revenue stream for the owners?

To whom is the doctor beholden: the team that pays the bills, or the million-dollar athlete who trusts the doctor for an objective opinion?

These are ethical issues of Socratic proportions.

Top sports medicine experts readily admit there are major ethical considerations for physicians, surgeons and other medical staff who care for athletes, but they add that it is the athlete who has the final say on whether to play.

"There is potential [for conflicts of interest], although most people walk the line pretty well," said Dr. Robert Leach, who was the team doctor for the Boston Celtics from 1969 to 1988 and who also served as a physician for the U.S. Olympic team. "If you're paid by the team, you're obviously a part of the team, but I honestly believe that doctors put their patients first. The problem now is that being a team physician has become such a marketing tool that it can interfere, but you do have to have results."

Sports medicine is evolving into big business just as the health-care industry is becoming more competitive. Physician groups and giant, for-profit health-care companies are hustling to land contracts with major sports teams, while owners see health-care providers as another source of revenue badly needed during the era of free agency.

The combination breeds all kinds of potential conflicts.

"It is a difficult problem," said Dr. Harlan Selesnick, team physician for the Miami Heat. "People will come in and offer $500,000 to a team saying they want to be the doctors, and it's becoming very common. It's becoming more of a problem as owners look for additional revenue."

So how do players and management know they are getting the best qualified physician care?

The answer is that nobody really knows.

"Everybody hopes that you're the best guy, but what does that really mean?" Leach said. "It is very subjective. If you've got two doctors and both are good, who really knows who is the best doctor?"

While there are instances of doctors bending to the pressure of management to put players back on the field, physicians say that is becoming less of an issue for two reasons: Owners are paying players too much money to risk further injury, and players, owners and agents have grown more knowledgeable about treatments.

"Clearly some people will always perceive that you'll do what management wants, but management has become more sophisticated and won't allow players to play [hurt]," Selesnick said.

In some instances, team physicians act as independent contractors and are paid by the players, a structure that eliminates the notion that physicians are pawns of the owners.

"When I was with the Celtics, I was an independent operator, but it is easy for owners and coaches to pressure," Leach said. "But as a physician, you always have to answer to yourself and the player."

In the end, the responsibility to the player should take care of any ethical dilemmas caused by owners and coaches who pressure physicians.